To be able to send this communication internet connectivity and a browser that allows form submission via email is required on your PC.  Alternatively you can call us at 800.226.6960 and ask for Carmen, or you can email your BOM/List to sales@bocasemi.com All information that is filled out below is treated highly confidential and will only be used by responsible BSC personnel. Neither your name nor address will be used for any other reason than for the information and/or documentation you request to be sent to you. Company Name: Contact Name: Position/Department: E-Mail Address: Street Address: Suite or Office: City, State and Zip: Phone Number: Fax Number: Business Type: Manufacturer OEM Contract Manufacturer Distributor/Dealer/Rep Consultant Design House Other Product Application: Industrial Medical Home Appliance White Goods Automotive Audio Video Telecom Specify Or Specify Is This a New Project ? Yes  No  Project Name: Product Stage: Concept Design Prototype Pre Production Production Production Start Time: Immediately 1-3 Months 4-6 Months 7-12 Months Over 12 Months Device Type Device Part Numbers Total Quantity Per Device Quantity Per Month (optional) Quantity Per Shipment Industry P/N Special * Pieces K Pieces Pieces K Pieces Pieces K Pieces Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Transistor SCR's TRIACS Rectifiers Application: Industrial Medical Home Appliance White Goods Automotive Audio Video Telecom Specify or Specify: Are Samples Needed? Yes No Tolerance:   % Additonal Information: Special Requirement: